JP4851468B2 - Refractive surgery eye alignment system - Google Patents

Refractive surgery eye alignment system Download PDF

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JP4851468B2
JP4851468B2 JP2007543574A JP2007543574A JP4851468B2 JP 4851468 B2 JP4851468 B2 JP 4851468B2 JP 2007543574 A JP2007543574 A JP 2007543574A JP 2007543574 A JP2007543574 A JP 2007543574A JP 4851468 B2 JP4851468 B2 JP 4851468B2
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data set
system
reference data
real
image
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JP2008521508A (en
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エー. カンピン,ジョン
ピー. グレイ,ゲアリー
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アルコン リフラクティブホライズンズ,インコーポレイティド
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Priority to US10/999,268 priority patent/US7815631B2/en
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Priority to PCT/US2005/042952 priority patent/WO2006060323A1/en
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007Methods or devices for eye surgery
    • A61F9/008Methods or devices for eye surgery using laser
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007Methods or devices for eye surgery
    • A61F9/008Methods or devices for eye surgery using laser
    • A61F9/00802Methods or devices for eye surgery using laser for photoablation
    • A61F9/00804Refractive treatments
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B3/00Apparatus for testing the eyes; Instruments for examining the eyes
    • A61B3/10Objective types, i.e. instruments for examining the eyes independent of the patients' perceptions or reactions
    • A61B3/113Objective types, i.e. instruments for examining the eyes independent of the patients' perceptions or reactions for determining or recording eye movement
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B3/00Apparatus for testing the eyes; Instruments for examining the eyes
    • A61B3/10Objective types, i.e. instruments for examining the eyes independent of the patients' perceptions or reactions
    • A61B3/14Arrangements specially adapted for eye photography
    • A61B3/15Arrangements specially adapted for eye photography with means for aligning, spacing or blocking spurious reflection ; with means for relaxing
    • A61B3/152Arrangements specially adapted for eye photography with means for aligning, spacing or blocking spurious reflection ; with means for relaxing for aligning
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007Methods or devices for eye surgery
    • A61F9/008Methods or devices for eye surgery using laser
    • A61F2009/00844Feedback systems
    • A61F2009/00846Eyetracking
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007Methods or devices for eye surgery
    • A61F9/008Methods or devices for eye surgery using laser
    • A61F2009/00861Methods or devices for eye surgery using laser adapted for treatment at a particular location
    • A61F2009/00872Cornea

Description

  This application claims priority under US Patent Act No. 120 to copending US patent application Ser. No. 10 / 999,268, filed Nov. 30, 2004, which is incorporated herein by reference in its entirety. To do.

  The present invention relates to systems and methods for improving objective measurements prior to vision correction surgery, and more particularly to systems and methods for improving the results of corrective laser surgery on the eyeball.

  Laser in situ corneal curvature (LASIK) is a common type of laser vision correction. This has proven to be a very effective outpatient procedure for a wide range of vision correction prescriptions. The use of an excimer laser provides high accuracy and predictability when shaping the cornea of the eyeball. Prior to the LASIK procedure, eye measurements are taken to determine the amount of corneal material to be removed from various locations on the corneal surface so that the excimer laser can be calibrated and guided to provide a pre-determined corrective prescription. To do. Refractive laser surgery for astigmatism correction usually requires the application of a cylindrical or pseudo-cylindrical ablation profile to the eyeball. In order to correct the visual aberration correctly, the long axis of this profile must be properly oriented on the eyeball.

  An objective measurement of the patient's eye is usually performed with the patient in an upright position and focused on the target image. The wavefront analyzer then determines the appropriate wavefront correction to reshape the cornea to direct the eyeball being examined. Then, LASIK or PRK treatment is performed with the patient in the prone position and the eyeball facing upward.

  It is well known that when a patient moves from an upright measurement position to a prone surgical position, the eyeball experiences intraorbital movement ("Cyclo® Torsion") with translation and rotation. Techniques well known in the art to accommodate this movement are marking the eyeball by cauterizing a reference point on the eyeball using a cautery device (US Pat. No. 4,476,862) or a cauterizing material. This was a very uncomfortable treatment for the patient. It is also known to mark the cornea using a plurality of blades (US Pat. No. 4,739,761). It is also known to mark or reference a reference position to identify the direction of the eye being measured, and to apply or inject a dye or ink to the sclera surface to position the correction profile in the same direction as before surgery. However, since there is a time delay from measurement to surgery, ink flows and often affects the accuracy of alignment. The method of marking on the eyeball (US Pat. No. 4,705,035) avoids the influence of the cauterization method and the influence of ink flow. However, the imprint can become smeared quickly compared to the period between measurement and surgery.

  In the correction of astigmatism, it is known to mark the cornea in preparation for making a surgical incision (US Pat. No. 5,531,753).

  A tracking system used to simply track eye movements during a surgical procedure or when a patient is in a fixed position is an eye movement data from a mark formed on the cornea using a laser beam prior to surgery. (US Pat. No. 4,848,340) and, for example, (US Pat. Nos. 5,029,220, 5,098,426, 5,196,873, 5,345, No. 281, No. 5,485,404, No. 5,568,208, No. 5,620,436, No. 5,638,176, No. 5,645,550, No. 5,865,832. 5,892,569, 5,923,399, 5,943,117, 5,966,197, 6,000,799, 6,027,216) In the eyeball, such as the retina or corneal margin Other things to receive eye movement data is known from obtaining their data highlights the features on the eye.

  Shared US Pat. No. 6,702,806, US Patent Application Nos. 2004/0143245, and 2004/0143244 use image mapping and manipulation and calculate graphical reticles to calculate actual eyeball images. The software on top of it addresses the problem of aligning the pre-operative image with the actual eyeball image.

  The present invention is directed to an orientation system and method for vision correction surgery that aligns pairs of eye images taken at different times. An exemplary embodiment of the method includes retrieving a reference data set comprising stored digital image data relating to a patient's eye. Stored image data is collected from a patient in a pre-operative position. Such data includes image data relating to features of the extracorneal eyeball.

  A real-time data set comprising digital image data relating to the patient's eyeball at a different surgical position than the pre-operative position is collected. Such real-time image data includes image data relating to features of the extracorneal eyeball.

  And displaying a combined image comprising a superposition of the reference data set and the real time data set, and whether the combined image indicates a sufficient alignment between the reference data set and the real time data set. Make a decision. Such a determination is made based on feature data of the extracorneal eyeball in the reference data set and the real time data set. If the alignment is not sufficient, one of the reference data set and the real-time data set is manipulated, ie translated and / or rotated, until sufficient alignment is achieved.

  The system of the present invention is directed to apparatus and software for a correction program for eye surgery. The system includes means for performing the method steps outlined above and includes computer software for achieving superposition of the reference data set and the real time data set.

  That is, one aspect of the present invention provides a system and method for achieving precise alignment of the eyeball by confirming that the eyeball features are at substantially the same location on the superimposed image. . As a result, for example, prescription measurements for reshaping the cornea involve the rotation and translation of the eyeball that occurs between measurements performed on a sitting patient and laser surgery performed on a supine patient. It will be considered.

  The features of the present invention, both in terms of organization and operation, as well as further objects and advantages thereof, will be better understood from the following description taken in conjunction with the accompanying drawings. It will be clearly understood that these drawings are for purposes of illustration and description and are not intended to define the limitations of the invention. These and other objects and advantages provided by the present invention will become more fully apparent from the following description taken in conjunction with the accompanying drawings.

  A preferred embodiment according to the present invention will now be described with reference to FIGS.

  A schematic diagram of the system 10 of an embodiment of the present invention is shown in FIG. 1, the data flow of an exemplary embodiment of the method 100 is shown in FIGS. 2A and 2B, and the displayed images are shown in FIGS. In an exemplary embodiment of system 10, the patient's eye 11 is imaged in a substantially upright position by capturing a first video image 12 using a camera, such as an electro-coupled device (CCD) camera 13 ( Block 101). This image 12 is illustrated in FIG. A first image comprising a reference data set is stored in a database 14 that is in electronic communication with the processor 15.

  Next, although not intended to be limiting, an objective measurement on eyeball 11 is made using measurement system 16 such as that disclosed in co-pending application 09 / 566,668 to obtain the desired correction profile. A decision is made (block 102).

  Once the correction profile is determined, the patient is prepared for surgery and placed in the second position, which is usually in the prone position. Alternatively, a first scan may be performed to determine a correction profile at a different location at some point prior to the surgical procedure, e.g., several weeks ago.

  A second camera 18 in communication with the second system 38 for performing the surgery is used to collect pre- and intra-operative real-time image data and store such data in the database 14 as well. In the preferred embodiment, both the first camera 13 and the second camera 18 are adapted to collect color images, and these images are converted into pixel data using software located on the processor 15. . Collecting a color image for viewing by a physician is useful, because the red color of the blood vessel 21 is clearly identifiable, so that a preselected identifiable image such as the blood vessel 21 (FIG. 3) is strong. This is because it looks easier in the film 23.

  Next, the surgeon identifies a plurality of features of the eyeball 11 using a graphical user interface (GUI) while viewing a still image of the eyeball (FIG. 3). These features may include a preferred center 40 of the cornea 41 in the reference set (block 103), the location of the corneal edge 42 (block 105), and the location of extracorneal features such as blood vessels 21 (block 107). . The system then includes a reticle 43 with cross-hatching 45, with a central circle 46 centered on the corneal center 40 and smaller than the corneal edge 42, and an intersecting vertical line 44 where the intersection of the straight lines 44 coincides with the corneal center 40. Indications for display overlaid on the reference data are generated (block 104). The indication also includes an annulus 47 located on the corneal rim 42 (block 106).

  Then, the pixel data is removed from all pixels circumscribed by the corneal border 42 (block 108, FIG. 4), and the reference data set is manipulated by removing the pixel data from the range 48 beyond the normal corneal border 42. Yields a reduced reference data set.

  A real-time data set comprising real-time digital image data for the patient's eyeball 11 at a different surgical position than the pre-operative position is collected before and during the operation (block 109). The real-time image data includes image data related to the blood vessel 21. Next, one of the reference data set and the real time data set is scaled to fit the other of the reference data set and the real time data set. This scaling is performed in order to equalize the display sizes of the reference data set and the real time data set for subsequent display in the superimposed image.

  The pixels of the first reduced reference data set are then sampled to produce a second reduced reference data set (block 111, FIG. 5). This sampling preferably takes the form of removing data from a predetermined pattern of pixels, leaving a data set with data in all pixels other than those in the predetermined pattern. An example of a predetermined pattern is one with every other pixel. Since the blood vessel 21 is clearly visible in FIG. 5, it has been shown that no significant resolution loss has occurred that would prevent the blood vessel 21 from being identified by sampling.

  The pixels in the real-time data set are then sampled by removing the pixel data from the set of pixels in the real-time data set that do not have common elements with those of the second reduced reference data set (block 112) and reduced Produces a real-time data set.

  Next, the second reduced reference data set and the reduced real time data set are summed (block 113), and each pixel in the summed set is a single unit of the second reduced reference data set and the reduced real time data set. To include data from one thing. The superimposed image with the sum is displayed (block 114, FIG. 6).

  Considering FIG. 6, the images of blood vessels 21 from the second reduced reference data set and the reduced real time data set appear clearly, indicating that they are not aligned (block 115). In this case, one automatic or manual operation of the data set is performed (block 116) until sufficient alignment is achieved (block 115), and the data processing started at block 111 is performed again.

  If alignment is deemed sufficient, the surgical procedure can begin (block 117) and monitoring during surgery continues. That is, the treatment pattern, which is a normal laser shot pattern calculated to achieve the desired corneal profile using, for example, an excimer laser, takes into account the eyeball rotation resulting from the patient's movement from the upright position to the prone position. It can be corrected.

  In the above description, some terms are used for brevity, clarity and understanding, but these terms are used in this application for explanation purposes and are intended to be interpreted broadly. It does not imply unnecessary restrictions beyond the requirements of the prior art. Furthermore, the device embodiments illustrated and described in this application are exemplary, and the scope of the present invention is not strictly limited to the details of this configuration.

  Although the present invention has been described above, the configuration, operation and use of the preferred embodiment of the present invention, the advantageous new and useful results obtained thereby, the new and useful configurations, and the reasonable obvious to those skilled in the art Mechanical equivalents are set forth in the appended claims.

It is the schematic of the system of the 1st Embodiment of this invention. It is a block diagram of a data flow. It is a block diagram of a data flow. It is a figure which illustrates a reference data set image. FIG. 4 is a diagram illustrating the reference data set image of FIG. 3 from which a central range including a range in the corneal margin is removed. It is a figure which illustrates a part of sample reference data set image further expanded. FIG. 6 illustrates the sample reference data set image of FIG. 5 mated with a sample real time data set image.

Claims (21)

  1. A system for directing a correction program for eye surgery,
    A database containing a reference data set comprising digital image data relating to a patient's eye, wherein the image data is collected from the patient at a pre-operative position and includes image data relating to extracorneal eye features;
    A processor and a display device for communicating signals with each other;
    A camera for collecting a real-time data set comprising real-time digital image data relating to a patient's eye at a surgical position different from the pre-operative position, wherein the real-time image data comprises image data relating to features of the extracorneal eyeball. Including
    Computer software located on the processor, comprising:
    Retrieving the reference data set from the database;
    Displaying a combined image of the reference data set and the real-time data set superimposed;
    Whether the combined image shows sufficient alignment between the reference data set and the real-time data set based on the features of the extra-corneal eyeball in the reference data set and the real-time data set Receive a decision about
    If not enough the alignment, until a sufficient alignment is achieved by operating the one of the reference data set wherein the real-time data sets,
    Organizing the reference data set and the real time data set into pixels;
    Sampling the pixels of the reference data set to produce a reduced reference data set;
    In order to produce reduced real-time data by removing pixel data from a set of pixels in the real-time data set that do not have a shared element with that of the reduced reference data set that includes data, the Sample pixels,
    The reduced reference data set and the reduced real time data set are summed to obtain a superimposed image, and each pixel is derived from only one of the reduced reference data set and the reduced real time data set that form the combined image. Including data for
    Computer software with code segments adapted to
    The system characterized by having.
  2.   The system of claim 1, wherein receiving the determination comprises receiving input from an operator based on visualization of the displayed combined image to the operator.
  3.   The system of claim 2, wherein the software further comprises a code segment for receiving operator input for performing operations on the data set.
  4.   The system of claim 1, wherein the software further comprises a code segment for automatically determining whether the combined image has sufficient alignment.
  5.   The system of claim 4, wherein the software further comprises a code segment for calculating an operation of the data set based on the determining step.
  6.   The system of claim 1, wherein the stored image data comprises camera data organized in pixels.
  7.   The system of claim 1, wherein the features of the extracorneal eyeball include blood vessels in the sclera of the eyeball.
  8.   The software further uses one of the reference data set and the real-time data set as the reference data to equalize the display size of the reference data set and the real-time data set displayed in the superimposed image. The system of claim 1, comprising a code segment for scaling to the other of the set and the real-time data set.
  9.   The system of claim 1, wherein the software further comprises a code segment for determining a suitable center of the cornea of the eye in the reference data set.
  10.   The software further comprises a reticle centered on the determined preferred corneal center and a code segment for displaying an image of the reference data set with indications superimposed thereon. The described system.
  11.   The system of claim 10, wherein the reticle has a pair of substantially vertical straight lines that intersect at the determined center of the preferred cornea.
  12.   The system of claim 11, wherein the reticle further comprises a plurality of substantially vertical hatch marks disposed substantially equidistant along the straight line.
  13.   The system of claim 11, wherein the reticle further comprises a circle substantially smaller than the cornea centered at the determined preferred cornea center.
  14.   The system of claim 9, wherein the software further comprises a code segment for determining a position of a corneal edge of the eye in the reference data set.
  15.   The software is further configured to display the reference data set with a second indication centered on the determined preferred corneal center and positioned along the determined corneal rim position and overlaid thereon. The system of claim 14, comprising a code segment.
  16. The software further comprises:
    Displaying the reference data set;
    A code segment for searching for features of the extracorneal eyeball in the displayed reference data set;
    The alignment is sufficient that images of the extracorneal eye features from the reference data set and the real-time data set are aligned in the combined image, and sufficient alignment is sufficient. The system of claim 1, wherein the system is determined by determining whether it is compatible with correct alignment.
  17. The system of claim 1 , wherein a code segment that samples pixels of the reference data set is adapted to remove pixel data from every other pixel.
  18. A code segment that samples the pixels of the reference data set is adapted to determine the position of the corneal edge of the eye in the reference data set and to remove data from all pixels that the corneal edge circumscribes. The system of claim 1 .
  19. The system of claim 18 , wherein a code segment that samples pixels of the reference data set is adapted to remove pixel data from every other pixel outside the cornea edge.
  20.   The system of claim 1, further comprising means for performing surgery on the eyeball if the alignment is sufficient.
  21. 21. The system of claim 20 , wherein the means for performing eye surgery comprises an excimer laser and a controller adapted to achieve a desired corneal profile.
JP2007543574A 2004-11-30 2005-11-29 Refractive surgery eye alignment system Active JP4851468B2 (en)

Priority Applications (3)

Application Number Priority Date Filing Date Title
US10/999,268 2004-11-30
US10/999,268 US7815631B2 (en) 2004-11-30 2004-11-30 Eye registration system for refractive surgery and associated methods
PCT/US2005/042952 WO2006060323A1 (en) 2004-11-30 2005-11-29 Eye registration system for refractive surgery and associated methods

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JP2008521508A JP2008521508A (en) 2008-06-26
JP4851468B2 true JP4851468B2 (en) 2012-01-11

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JP (1) JP4851468B2 (en)
KR (1) KR101210982B1 (en)
CN (1) CN101068515A (en)
AT (1) AT540651T (en)
AU (1) AU2005312053B2 (en)
BR (1) BRPI0518711B1 (en)
CA (1) CA2588843C (en)
ES (1) ES2379000T3 (en)
MX (1) MX2007006433A (en)
WO (1) WO2006060323A1 (en)

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